Mail order pharmacy use safe for people with diabetes

Most people with diabetes can safely get their medications though mail order pharmacies, a new study suggests.

Among some patients, getting drugs through the mail instead of in person was tied to a lower risk of ending up in the emergency department (ED), researchers found.

Mail order pharmacies are convenient, especially for people with disabilities or who can’t get to the pharmacy to pick up their regular orders, researchers said. But there have been concerns about those systems as well - for instance that people might miss out on important information by not seeing a pharmacist face-to-face.

“Mail order pharmacy use is actually fairly common in the United States and has become more and more so over the past 10 or 15 years,” Julie Schmittdiel told Reuters Health.

She is with the Kaiser Permanente Division of Research in Oakland, California. Kaiser Permanente is a large healthcare organization that offers mail order pharmacy services to its members.

Schmittdiel said few studies have looked at how the use of mail order affects quality of care and if there are negative consequences to getting medication through the mail. She previously found mail order pharmacy use had a positive impact on cholesterol management.

For the new study, Schmittdiel and her colleagues analyzed medication and hospital records for 17,217 Kaiser Permanente patients with diabetes who were prescribed new heart drugs in early 2006.

The researchers found 34 percent of patients under age 65 who used mail order made trips to the ED during the three years after starting their medication. That compared to 40 percent of those who used traditional pharmacies.

But mail order users were also less likely to get certain follow-up lab tests. Forty-one percent of them had tests to check for side effects soon after starting new drugs, compared to 47 percent of people who got their medications in person.

Among adults age 65 and older, those using mail order had fewer ED visits that were considered preventable with appropriate care. About 13 percent of them had a preventable visit, compared to 16 percent of traditional pharmacy users. There was no difference in total ED visits.

A few more of the older adults who used mail order had overlapping shipments of medications that were contraindicated, meaning they shouldn’t be taken together. But that happened about one percent of the time or less among both groups, the researchers reported in the American Journal of Managed Care.

“For the general population, we didn’t really see any safety impacts. We did see, in patients who were younger than 65, a very slight difference in having some lab monitoring tests done,” Schmittdiel said. That could be related to younger people being more likely to work and less likely to get to the lab, she added.

“For the most part, what we saw is what we had seen in our previous work, a positive relationship between mail order pharmacy use and better healthcare outcomes such as lower use of emergency departments,” she said.

Why that was the case isn’t clear.

The fact that the researchers did not take into account the severity of people’s diabetes and other health conditions means it’s hard to pin the better outcomes on mail order pharmacy use itself, Michael Rupp told Reuters Health in an email.

He has studied attitudes toward mail order pharmacy at Midwestern University in Glendale, Arizona, and wasn’t involved in the new study.

“An equally plausible explanation for the correlation is that sicker patients recognize the severity of their illness and prefer to obtain their medications from a local pharmacy where they can routinely interact with their pharmacist,” Rupp said. His own work among older patients has suggested that might be the case.

“The goal of our research was not to mandate mail order pharmacy use and say that it’s the right answer for everyone,” Schmittdiel said.

“We really believe in patient choice and helping patients to figure out what option is right for them, but what we are trying to say is that the benefits of increased access to a system like a mail order pharmacy might really be useful to more people that are perhaps not using the service right now,” she said.

“We’d like to see more research and more quality improvement work done to help expand that access to the group of people that might benefit and that might find this to be an option that works for them.”

“I believe most people are practical and pragmatic about mail order, especially older people who take the majority of prescription drugs,” Rupp said. “They recognize its advantages but are also aware of its disadvantages and limitations.”

Safety and Effectiveness of Mail Order Pharmacy Use in DiabetesBackground: Although research suggests that mail order pharmacy use is associated with greater medication adherence and cardiovascular disease risk factor control, no research has examined the potential impact of mail order pharmacy use on patient safety and utilization.
Objectives: To compare safety and utilization outcomes in patients using mail order versus local pharmacies.
Study Design: Cross-sectional, observational study of 17,217 Kaiser Permanente Northern California adult diabetes patients prescribed new cardiometabolic medications in 2006.
Methods: Multivariate logistic regressions assessed the association between mail order pharmacy use and all-cause and preventable hospitalizations and emergency department (ED) visits; laboratory tests for monitoring persistent medications; and overlapping days of supply of contraindicated medications. Results were stratified by patient age and converted to adjusted predicted percentages.
Results: Patients aged less than 65 years using mail order had fewer ED visits (33.8% vs 40.2%; P Conclusions: Mail order pharmacy use is not associated with adverse outcomes in most diabetes patients, and is associated with lower ED use. Interventions to increase mail order pharmacy use should use a patient-centered approach that is sensitive to primary and preventive care access. - See more at: http://www.ajmc.com/publications/issue/2013/2013-1-vol19-n11/Safety-and-Effectiveness-of-Mail-Order-Pharmacy-Use-in-Diabetes#sthash.we91a6j2.dpufJulie A. Schmittdiel, PhD; Andrew J. Karter, PhD; Wendy T. Dyer, MS; James Chan, PharmD, PhD; and O. Kenrik Duru, MD, MSHS